Assessment of Quality of Life and Drug Prescription Pattern in Acute Coronary Syndrome

Abstract

Objectives: To assess the health-related quality of life (QOL) in patients with acute coronary syndrome (ACS) and predict those patients who may have worsened QOL 6 months later and also observe the prescribing patterns of drugs given in their treatment. Materials and Methods: A prospective observational study was conducted at the cardiology department in a tertiary care hospital. The data were collected in both inpatient and outpatient cardiology departments based on our inclusion and exclusion criteria for a period of 6 months. A total of 240 patients were analyzed with a data collection form by interviewing the patients about their sociodemographic details, laboratory parameters, and diagnostic reports. The MacNew Heart Disease Questionnaire, Medical Research Council Breathlessness Scale, and New York Heart Association (NYHA) Functional Scale were used for assessing the QOL in patients with ACS. We calculated Global Registry of Acute Coronary Events Score and Thrombolysis in Myocardial Infarction Score for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) patients for identifying the mortality risk. Results: Urban people were more prone to ACS than rural people, according to our data. According to the NYHA Functional Classification, ability to do physical activity was more considerably affected in NSTEMI patients than STEMI and angina. Most of the patients had Grade 2 shortness of breath. 35% of the patients had a high mortality risk. Based on the MacNew Questionnaire data, 23% of the patients with ACS were doing emotionally poor, 45% of the patients had shown physically impaired symptoms, 28% of the patients were socially dependent, 8% of the patients showed poor gastric condition. 49% of the patients were given reperfusion therapy with either percutaneous coronary intervention (PCI) or coronary artery bypass graft, 25% of the patients were managed with dual-anticoagulant therapy, and 6% of the patients were treated with single-anticoagulant therapy. Commonly prescribed drug classes were statins (90%), antiplatelets (86%), anticoagulants (75%), antianginal (55%), beta-blockers (50%), diuretics (35%), angiotensin-converting enzyme inhibitors (18%), and angiotensin receptor blockers (16%). Conclusion: QOL was significantly affected in ACS patients. Most of the patients had risk factors for ACS. Patients explained impairments in all the four domains used in the questionnaire such as emotional, physical, social, and gastric impairments. QOL was more affected in STEMI patients and they had a high mortality risk. Most of the patients had NSTEMI. Low-risk patients were given single-anticoagulant therapy and medium-risk patients were treated with dual-anticoagulant therapy. PCI was preferred in almost all the patients.

A Prospective Cross-Sectional Study of Acute Coronary Syndrome Patients’ Quality of Life and Drug Prescription Patterns at Riyadh Region Hospitals, Saudi Arabia

“…Among the 356 patients, 184 (51.69 percent) were diagnosed with NSTEMI, 105 (29.49 percent) with STEMI, and 67 (18.82 percent) with angina. Andhi et al, 2022 and Saju et al, 2020 found that the majority of patients had chest pain as the primary symptom, followed by shortness of breath and profuse perspiration, which was consistent with our findings [ 5 , 11 ]. Thus, patients with ACS risk factors must be educated by healthcare providers to seek emergency treatment when experiencing these symptoms.…”

“…In other words, rising age reduces HRQOL’s physical health. Furthermore, Andhi et al (2022) suggested that older age might predict poorer HRQOL in ACS patients [ 11 ]. Interestingly, another study found no correlation between age and quality of life.…”

“…Age, aspirin usage in the previous week, number of angina episodes in the previous 24 h, high blood myocardial necrosis markers or enzymes, ST-segment deviation, history of coronary artery disease, and the presence of three risk factors for heart disease all contribute to the TIMI risk score for patients with NSTEMI. Low-risk individuals have scores ranging from 0 to 2, intermediate-risk patients have scores ranging from 3 to 4, and high-risk patients have scores ranging from 5 to 7 [ 11 , 23 ]. However, the TIMI risk score for STEMI patients was determined by adding points for the following factors: patient age, presence of diabetes, hypertension, or angina, systolic blood pressure < 100 mmHg, heart rate > 100 beats per minute, Killip Class II-IV, weight < 67 kg, anterior ST elevation or LBBB, and time to treatment > 4 h. Where, Score 0: 30 Day Mortality is 0.8%, Score 1: 30 Day Mortality is 1.6%, Score 2: 30 Day Mortality is 2.2%, Score 3: 30 Day Mortality is 4.4%, Score 4: 30 Day Mortality is 7.3%, Score 5: 30 Day Mortality is 12.4%, Score 6: 30 Day Mortality is 16.1%, Score 7: 30 Day Mortality is 23.4%, Score 8: 30 Day Mortality is 26.8%, and Score > 8: 30 Day Mortality is 35.9% [ 29 ].…”

“…HRQOL measurements evaluate a patient’s experience with health problems in areas such as physical, emotional, and social functioning, performance role, pain, and tiredness. A poor HRQOL score can have an impact on the process of recovery, decrease treatment adherence, diminish the capacity to conduct activities of daily living, raise hospital readmission rates, and place the patient at risk for complications and mortality [ 5 , 11 ].…”

“…The STEMI Thrombolysis in Myocardial Infarction (TIMI) Risk Score is a basic risk assessment score that may be utilized at the bedside. In patients with NSTEMI and unstable angina, the TIMI score predicts ischemic events and mortality [ 11 , 23 ]. However, the Medical Research Council’s Breathlessness (MRCB) scale and the New York Heart Association (NYHA) scale were used to assess the patient’s physical affection [ 11 ].…”